Wednesday, August 22, 2012

Top Concerns of ACOs: Reducing Clinical Variation, Cost of Care

Among hospitals that currently are participating in an accountable care organization (ACO), the top 3 challenges they encounter are reducing clinical care variation, reducing the cost of care, and developing and maintaining a common culture among the various ACO partners, says a new issue brief by the Commonwealth Fund. Increasing the size of the covered patient population, developing an information system infrastructure, and accessing capital to invest in the ACO model are the top concerns of hospitals preparing to partici­pate in an ACO.

As of summer 2012, 154 groups are participating in ACO initiatives sponsored by the Centers for Medicare and Medicaid Services (CMS). Thirty-two organi­zations have signed contracts to become Pioneer ACOs, 116 organizations have enrolled in the CMS Shared Savings Program, and 6 have joined the Physician Group Practice Transition demonstration program. In all, more than 2.4 million Medicare ben­eficiaries are receiving care from providers participat­ing in these initiatives.

Numerous other organizations have contracts with private payers that include many of the key features of the ACO model. A recent report identified 221 ACOs in 45 states as of May 2012. This number includes both CMS and private sec­tor ACOs.

Nineteen percent of hospitals participating or preparing to participate in an ACO report using predictive tools to identify patients at high risk of poor health outcomes or high resource use, compared with 9% of those not exploring the ACO model. Further, 28.4% of those participating or preparing to participate in an ACO report managing high-volume, high-cost patients using experienced case managers, compared with 19.5% of those not exploring the ACO model.

Only 50% of hospitals currently participating in an ACO track performance data; the other half plans to do so within the next 3 years.

All hospitals—regardless of whether they are participating in ACOs, in planning phases, or not considering the model—expect an average 11% decrease in the percent of their revenue coming from fee-for-service payments in the next 3 years.